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Experts Offer Clarity on Confusion Surrounding Stents
Date:2/22/2008

restenosis, after the insertion of a bare-metal stent was close to 30 percent. To circumvent that problem, researchers developed drug-eluting stents, which emit medicines that prevent restenosis. A majority of patients who need a stent now receive one of these devices, which cost about $2,000 each, double the price of a bare-metal stent.

In recent years, the Taxus and Cypher drug-eluting stents have dominated the field, and conflicting studies comparing their relative effectiveness appear regularly in major medical journals. A third drug-coated stent, Medtronic's zotarolimus-coated Endeavor, received U.S. Food and Drug Administration approval earlier this month.

But even drug-coated stents aren't perfect. Soon after they gained widespread use, experts began to notice that rates of fatal or nonfatal blood clots were more likely in patients who received a drug-coated stent versus those who did not. This excess clotting risk was confirmed in later trials. For that reason, the FDA recommends that patients who receive drug-eluting stents be placed on dual anti-platelet therapy -- typically Plavix (clopidogrel) and aspirin -- for a year after they receive the device.

But are stents always the best option when arteries narrow or is bypass surgery sometimes a better choice?

In many cases, the answer to that question must still be decided on a case-by-case basis, the experts said. Studies suggest that in cases where only one vessel is blocked, stent placement (during minimally invasive angioplasty) may be a safer and equally effective option.

But a study published in the January issue of the New England Journal of Medicine found that when multiple vessels are blocked, bypass may be a better choice.

"This is really hazy issue," Garratt said. In more complex clinical situations, a surgeon must carefully weigh the pros and cons of each procedure before making a choice, he said.

If your cardiologist
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